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Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern.

Tarzamni MK, Nezami N, Ardalan MR, Etemadi J, Noshad H, Samani FG, Toufan M - Cardiovasc Ultrasound (2007)

Bottom Line: Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg.All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension.Careful physical examination should be performed in all hypertensive patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran. Tarzamni@yahoo.com

ABSTRACT

Background: Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg.

Aim: To describe a novel renal artery Doppler flow pattern pathognomonic of aortic coarctation.

Methods: We enrolled 4 consecutive patients referred to renal artery Doppler Ultrasonography (DU) for diagnostic work-up of secondary arterial hypertension. All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension.

Results: We found in all 4 patients (age range 10 to 27 years) a bilateral "parvus-tardus" renal Doppler flow pattern. In all, echocardiographic and angiographic work-ups showed aortic coarctation.

Conclusion: Careful physical examination should be performed in all hypertensive patients. Furthermore, the suspicion of AC can be raised by a bilateral renal arteries "parvus-tardus" Doppler flow pattern in young hypertensive patients screened for secondary hypertension.

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Related in: MedlinePlus

(A) Evaluation by TEE revealed aortic caorctation. (B) Recorded waveforms by cardiologist at post aorta coarctation locations.
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Figure 3: (A) Evaluation by TEE revealed aortic caorctation. (B) Recorded waveforms by cardiologist at post aorta coarctation locations.

Mentions: A 21-year-old male with six-month history of tacking beta blocker. He was referred by a general practitioner for investigation of his secondary hypertension. This suspicion arises from negative family history and risk factor, and development of resistant hypertension. During physical examination, BP was 160/100 mmHg in his left brachial. According to these findings and the assumption of RAS, DU evaluation of renal arteries was recommended. During Doppler examination, parvus-tardus pattern was demonstrated in both renal arteries (Fig. 1A, B) and extention to aorta (Fig 2), but no evidance compatible with renal artries stenosis was detected. Trans-Esophageal Echocardiography (TEE) revealed a stenotic region about 2 cm length in the thoracic aorta distal to the origination of left subclavicular artery (Fig. 3A, B). After diagnosis, there was a 60 mmHg differences between upper (brachial) and lower (popliteal) extremities systolic BP. Finally, his BP normalized after successful surgery procedure.


Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern.

Tarzamni MK, Nezami N, Ardalan MR, Etemadi J, Noshad H, Samani FG, Toufan M - Cardiovasc Ultrasound (2007)

(A) Evaluation by TEE revealed aortic caorctation. (B) Recorded waveforms by cardiologist at post aorta coarctation locations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211282&req=5

Figure 3: (A) Evaluation by TEE revealed aortic caorctation. (B) Recorded waveforms by cardiologist at post aorta coarctation locations.
Mentions: A 21-year-old male with six-month history of tacking beta blocker. He was referred by a general practitioner for investigation of his secondary hypertension. This suspicion arises from negative family history and risk factor, and development of resistant hypertension. During physical examination, BP was 160/100 mmHg in his left brachial. According to these findings and the assumption of RAS, DU evaluation of renal arteries was recommended. During Doppler examination, parvus-tardus pattern was demonstrated in both renal arteries (Fig. 1A, B) and extention to aorta (Fig 2), but no evidance compatible with renal artries stenosis was detected. Trans-Esophageal Echocardiography (TEE) revealed a stenotic region about 2 cm length in the thoracic aorta distal to the origination of left subclavicular artery (Fig. 3A, B). After diagnosis, there was a 60 mmHg differences between upper (brachial) and lower (popliteal) extremities systolic BP. Finally, his BP normalized after successful surgery procedure.

Bottom Line: Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg.All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension.Careful physical examination should be performed in all hypertensive patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran. Tarzamni@yahoo.com

ABSTRACT

Background: Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg.

Aim: To describe a novel renal artery Doppler flow pattern pathognomonic of aortic coarctation.

Methods: We enrolled 4 consecutive patients referred to renal artery Doppler Ultrasonography (DU) for diagnostic work-up of secondary arterial hypertension. All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension.

Results: We found in all 4 patients (age range 10 to 27 years) a bilateral "parvus-tardus" renal Doppler flow pattern. In all, echocardiographic and angiographic work-ups showed aortic coarctation.

Conclusion: Careful physical examination should be performed in all hypertensive patients. Furthermore, the suspicion of AC can be raised by a bilateral renal arteries "parvus-tardus" Doppler flow pattern in young hypertensive patients screened for secondary hypertension.

Show MeSH
Related in: MedlinePlus